How does the program address each survivor's body image issues?It's a very individualized program for patients. I meet with each patient one-on-one. When they come into the therapy program, I first try to understand what kinds of body image concerns they are having and how these issues are impacting their lives.

Based on that information, I design a treatment plan that helps them become more accepting of their body changes and gets them back to doing activities they used to enjoy and have been avoiding.

I don't expect them to get to the point where they feel great about how they look. I want patients to understand that there are going to be aspects of their appearance they do not like and to be accepting of this fact. I also work to help patients focus on other aspects of their body and appearance that they appreciate and enjoy. The point is not to have body image concerns interfere with one's daily life.

Do you provide medical advice to survivors?I don't provide medical advice. When patients are struggling with making a treatment decision that will affect their appearance and the way their body functions, I help them discuss the options presented to them by their physicians.

I go over the available options for each patient and their understanding of those options. We also talk about their understanding of the risks and the benefits.

These conversations help patients determine questions for their physicians, which, in turn, help them make informed decisions about their treatment.Are you doing any research on survivors' body image issues?The BITS program has a very strong research component. Our current studies are focused on gaining a greater understanding of how patients with breast and head and neck cancer adapt to body image changes following surgery and during reconstructive treatment. We're fortunate that very few patients refuse to participate in our research studies. I think it has to do with the strong interest survivors have in being helpful to other people. It's a very powerful and therapeutic experience.

My research and therapy program is very unique and as far as I know, it is unlike any other in the country. I get requests from all over the world for information on my program and my approach to treating patients with body image difficulties. How can survivors receive services through the BITS program?Our current research program targets patients undergoing breast reconstruction and newly diagnosed patients with head and neck cancer undergoing facial reconstruction. We actively recruit participants through their physicians and health care team.

At this time, therapy services are only available to patients being seen in the Center for Reconstructive Surgery and the Head and Neck Center. Typically, physicians, nurses or mid-level providers refer patients to the program. However, patients can self-refer, or may be recommended by a survivor who has participated in the program. We are continuing to work on ways to expand the therapy program and have it become more widely available to patients at MD Anderson. Outside of BITS, how can survivors improve their body image?It is important to recognize that most cancer patients, both men and women, experience difficulties adjusting to body image changes that result from cancer and its treatment. These difficulties can arise at any point during treatment -- even after treatment is completed.

I often remind patients to have compassion for yourself when experiencing distress or difficulties related to body image changes. Most of my patients are able to show extreme compassion toward other people in their lives; however, when it comes to their body image issues they are very judgmental and critical of themselves.

When survivors focus on what they don't like about their bodies or compare themselves to others or how they looked prior to their cancer treatment, it creates a vicious cycle and makes it more difficult to accept your body the way it is.